Modeling the Effect of Treatments on Prostate Cancer-Specific Mortality and the Relevant Geographical Variation and...

Area of Science:

• Oncology
• Health Services Research
• Epidemiology

Background:

• African American (Black) men face higher prostate cancer (PCa) mortality rates and reduced radical treatment utilization compared to European American (White) men.
• Geographical variations exist in PCa-specific mortality (PCSM) and mortality rates (PCSMR) between these racial groups.
• Understanding the influence of treatment on these disparities is crucial for improving outcomes.

Purpose of the Study:

• To investigate the impact of different treatments on PCSM and PCSMR.
• To analyze the role of treatment disparities in explaining racial differences in PCa mortality.
• To examine the correlation between treatment variations and geographical disparities in mortality.

Main Methods:

• Analysis of large datasets from the SEER (637,093 White, 110,839 Black) and PLCO (7463 White, 495 Black) databases.
• Utilized Cox proportional hazards models and regression-based mediation analysis.
• Incorporated data on PCa family history (pros_fh) from the PLCO dataset.

Main Results:

• Surgery alone was associated with significantly lower relative mortality risk (RR) compared to radiotherapy alone or combined treatments.
• Treatment disparities substantially reduced the estimated RR for Black patients when included in the model.
• Differences in surgery alone rates significantly correlated with racial disparities in PCSMR for high-grade or non-localized PCa.
• Treatment disparity directly impacted mortality disparity, independent of age disparity.

Conclusions:

• Geographical variations in treatment disparities partially explain variations in PCa mortality disparities in the United States.
• Surgery demonstrates a survival advantage over radiotherapy for PCa patients.
• Family history (pros_fh) did not significantly affect survival in the PLCO cohort.